Smart $aver Nonresidential Custom Incentive Application Proposed energy efficiency measures may be eligible for Custom Incentives if they clearly reduce electrical consumption and/or peak demand as compared to the appropriate baseline. Before you complete this application, please note the following important criteria: This application is not for customer accounts served by Duke Energy Progress. Please refer to the Energy Efficiency for Business program found at duke-energy.com/carolinasbusiness. Incentive approval is required PRIOR to equipment purchase or any other activity that would indicate that the Duke Energy account holder has already decided to proceed with the proposed project. If the vendor is the payee, the vendor must issue credit in the amount of the Custom Incentive to the customer on the invoices provided with the payment request submission. Submitting this application does not guarantee an incentive will be approved. Equipment eligibility and energy savings calculations requirements change over time. Past approval of similar equipment and/or similar calculations does not guarantee an incentive will be approved. Inquire about eligibility and requirements prior to applying. Incentives are based on electric conservation and peak demand reduction only. Electric demand and/or energy reductions must be well documented with auditable calculations. Simple payback after incentive must be greater than one year. Incomplete applications cannot be reviewed; all fields are required. Refer to the complete list of Instructions, Terms and Conditions, beginning on page 9. Notes on the Application Process If you have questions concerning how to complete any portion of the application or what supplementary information is required, please contact the Duke Energy Smart $aver team at 866.380.9580. Submit your completed, signed application with attachments via email or fax: Email: CustomIncentives@duke-energy.com Fax: 980.373.9755 Every application must include calculations of the baseline electrical usage and the electrical usage of the proposed high-efficiency equipment/system. These calculations are performed and submitted by the Duke Energy customer or designated equipment vendor/engineer. Custom calculation worksheets, Custom-to-Go calculators and page 7 of this application contain additional guidance on acceptable calculations. Engineering calculations should be accompanied by justification of key assumptions. Complex or unique projects may require the use, at the applicant’s expense, of modeling software. Please contact the Smart $aver team with questions about these requirements. If you do not receive an acknowledgment email within one day of submitting an application via online, email or fax, or within one week of sending an application via mail, please call 866.380.9580. The acknowledgment email will provide an estimated response time based on an initial assessment of your application. The application review may include some communication to resolve any questions about the project or to request additional information. Applications that are received complete without missing information have a faster review time. If you choose to proceed with your project before the review process is complete, you will forfeit eligibility. Page 1 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application 1. Contact Information (Required) Duke Energy Customer Contact Information1 Company Name Address City Project Contact State Mr. Zip Code Ms. Title Office Phone Mobile Phone Fax Email Address Equipment Vendor / Contractor / Architect / Engineer Contact Information Company Name Address City Project Contact State Mr. Zip Code Ms. Title Office Phone Mobile Phone Fax Email Address Who is the primary point of contact for technical questions?2 Payment Information If an incentive is awarded, who should receive payment?3 Customer Vendor (customer or customer’s agent4 must sign below) I hereby authorize payment of incentive directly to the vendor: Customer Signature ____________________________ Date____/___/______ (mm/dd/yyyy) Tax ID Number for Payee (provide W-9) Mailing Address for Payee (if different from above) Street City State Zip Code 1 Provided customer information should match the Duke Energy customer of record and W-9 form provided with this application. If the customer entity is a business affiliate of the Duke Energy customer of record, documentation must be provided that demonstrates the business affiliation. 2 Note that if the vendor is the primary point of contact, the customer will still be copied on all application correspondence. If the customer does not wish to be copied, the customer must provide a signed letter of authorization on customer letterhead indicating an entity is acting as an agent for the customer. Duke Energy does not act as an agent. 3 If payment is to be made to an entity other than the Duke Energy account holder or the vendor, a payment waiver is required and will be provided for customer signature. 4 If an outside agent is acting on behalf of the Duke Energy customer of record, a letter of authorization on customer letterhead and signed by an authorized employee of the customer must be provided. Page 2 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application 2. Project Information (Required) A. Please indicate project type: New construction (Duke Energy account number not yet established) Expansion at an existing facility (existing Duke Energy account number) Replacing equipment that is estimated to have remaining useful life of two years or less Replacing equipment that is estimated to have remaining useful life of more than two years B. Please describe your project, or attach a detailed proposal that describes the project. C. If awarded an incentive, when do you plan to start and complete implementation? Start date / (mm/yyyy) End date / (mm/yyyy) D. Are you also applying for Smart $aver Prescriptive Incentives and, if so, which one(s)5? E. Please indicate which worksheet(s) you are submitting for this application (check all that apply): Lighting Variable Frequency Drive (VFD) Compressed Air Energy Management System (EMS) General (for projects not easily submitted using one of the above worksheets) F. List all assumptions about the baseline and proposed equipment energy use and operation schedule, or attach a document listing that information. Attach spec sheets for all proposed new equipment. G. Attach a supplier or contractor estimate, engineer’s cost estimate and/or other equivalent information documenting the Implementation Cost and Alternate Baseline Cost, if applicable, for each project listed in your application. Does the Implementation Cost include any internal labor6? If yes, please specify which costs are internal labor. H. Was this project identified during a facility/system audit or energy assessment? Was the audit/assessment performed in conjunction with Duke Energy? Please attach a copy of the audit/assessment report. 5 If your project involves some equipment that is eligible for Prescriptive Incentives as well as some equipment that is likely eligible for Custom Incentives and it is feasible to separate the equipment for the energy analysis, the equipment will be evaluated separately. If it is not feasible to separate the equipment for analysis, the equipment will be evaluated together in the Custom application. 6 Internal labor costs cannot be counted in the Incremental Project Cost for purposes of analysis. Page 3 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application 3. Project Questionnaire (Required – must be completed by Duke Energy customer) A. What best describes the actions you would take within the next two years if the custom incentive is not approved for this application. Would you… a) b) Purchase and install the entire project as described in the application Purchase and install some, but not all, of the high efficiency equipment described in the application c) Purchase and install standard equipment, but not the high efficiency equipment described in the application d) Not purchase nor install any equipment described in the application e) Don’t know B. Was any part of the project for which you are applying for a Custom program financial incentive recommended in the energy audit/assessment provided to you by Duke Energy? Select only one response. a) b) c) d) Yes, it was recommended in the audit. No, it was not recommended in the audit. We are not sure or do not know if it was recommended. We have not had a Duke Energy energy audit or assessment in the last five years. C. In your opinion, did your participation in the Nonresidential Assessment program make it more or less likely that you or your company would take actions to save energy or reduce the energy costs for your business? Select only one response. a) b) c) d) e) f) g) It made it much more likely we would take actions. It made it more likely we would take actions. It had no effect on our desire to save energy or take actions. It made it less likely we would take actions. It made it much less likely we would take actions. We are not sure or do not know if it had an effect on our actions. We have not had a Duke Energy energy audit or assessment in the last five years. Page 4 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application 4. Signature (Required – must be signed by Duke Energy customer after reviewing application documents. Signature pages may not be submitted separately from the custom application.) Customer Consent to Release of Personal Information I, (insert name) , do hereby consent to Duke Energy disclosing my Duke Energy Account Number and Federal Tax ID Number to its subcontractors solely for the purpose of administering Duke Energy’s Smart $aver program. I understand that such subcontractors are contractually bound to otherwise maintain my Duke Energy Account Number and Federal Tax ID Number in the strictest of confidence. I realize that under the rules and regulations of the public utilities commission, I may refuse to allow Duke Energy to release the information set forth above. By my signature, I freely give Duke Energy permission to release the information designated above. I certify that I meet the eligibility requirements of the Duke Energy Smart $aver Custom Incentives program and that all information provided within this application is correct to the best of my knowledge. I agree to the terms and conditions set forth for this program. I certify that the numbers, energy savings and responses shown on this form are correct. Further, I certify that the taxpayer identification number is current and correct. I am not subject to backup withholding because: (a) I am exempt from backup withholding; or (b) I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the IRS has notified me that I am no longer subject to backup withholding. I am a U.S. citizen (includes a U.S. resident alien). Duke Energy Customer Signature Print Name Date Equipment Vendor / Contractor / Architect / Engineer Signature Print Name Date Page 5 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application Checklist for Completing the Application INCOMPLETE APPLICATIONS WILL RESULT IN PROCESSING DELAYS. Before submitting the application and the required supplementary information, use the following checklist to ensure that your application is complete and the information in the application is accurate (Note: This checklist is for your use only – do not submit this checklist with your application). Section No. & Title 1.Contact Information 2. Project Information 3. Project Questionnaire 4. Signature Supplementary information (Required) Have You: Completed the contact information for the Duke Energy customer? Completed the contact information for the equipment vendor /project engineer that can answer questions about the technical aspects of the project, if that is a different person than above? Provided required Tax ID Number and W-9 for payee? If the payment is to be sent to the vendor, the Duke Energy account holder must sign to authorize payment. Verified that Duke Energy customer contact information on page 2 matches the Duke Energy customer of record? Answered questions A-H, including providing a description of your project? Completed and attached the lighting, compressed air, VFD, EMS and/or general worksheet(s) or generated a Custom-to-Go calculator output? Attached a supplier or contractor estimate, engineer’s cost estimate, and/or other equivalent information documenting the Implementation Cost and Alternate Baseline Cost for each project listed in your application? (Note: Self-install costs cannot be included in the Implementation Cost.) Attached the audit/assessment report (if applicable) Completed questions 1-6? (Note: Check to ensure that you checked only one box for each.) Signed your name? Printed your name? Entered the date? Attached calculations documenting the energy usage and energy savings for each project listed in your application as well as spec sheets and other applicable information? If you have questions concerning how to complete any portion of the application or what supplementary information is required, please contact the Duke Energy Smart $aver team at 866.380.9580. Submit your completed, signed application with attachments via email or fax: Email: CustomIncentives@duke-energy.com Fax: 980.373.9755 Page 6 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application Preferred Customized Calculation Tools Please refer to the list below of preferred software tools to use when calculating the baseline electrical usage and the electrical usage of the proposed high-efficiency equipment or system. Click on each software tool to learn more. Software Tool Category eQuest Nonresidential retrofits and new construction EnergyPlus Nonresidential retrofits and new construction; whole building simulation Carrier® HAP HVAC Trane® TraceTM HVAC DOE OIT Pumping System Assessment Tool (PSAT) Pumps MotorMaster+ Motors AirMaster Air compressor systems EmersonTM Product Selection & Energy Analysis Refrigeration compressor retrofits using BIN analysis 2 (for projects of approximately 250,000 kWh or less). DOE2.2R Refrigeration measures SkyCalcTM Skylighting BinMaker® Weather data analysis tool AFT Fathom Fluid flow analysis for industrial systems Note that if a customized or proprietary calculation tool is used, all input and output files must be provided as well as a thorough description of the calculation methodology employed by the tool. All energy savings calculations and models should be accompanied by justification of key assumptions used. Whole building simulation models should be properly calibrated to existing utility bills. Page 7 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application Instructions/Terms/Conditions Note: Please keep for your records - do not submit with the application 1. Customers who opt out of the Energy Efficiency Rider are not eligible for Custom Incentives. 2. Before starting a custom energy efficiency project, the Duke Energy customer must complete and submit this application to Duke Energy for approval. Smart $aver Custom Incentives cannot be granted without prior completion of this application and subsequent approval by Duke Energy. Energy service companies or contractors may assist in preparing the application, but an authorized representative of the Duke Energy customer of record must sign this application to be eligible to participate in the Smart $aver program. Completion of this application does not guarantee the approval of a Custom Incentive. 3. Do not begin your energy efficiency projects, purchase equipment or otherwise make commitments to proceed with your project until you receive written approval in the form of an acceptance letter from Duke Energy, or your application will be rejected. 4. Once all documentation requested in this application is received by Duke Energy and any follow-up information requested by Duke Energy is received, the Preliminary Incentive Amount for each Energy Conservation Measure (ECM) will be communicated to the customer. The Preliminary Incentive Amount will be based on the projected energy savings and ECM incremental installation cost. 5. With the application, the customer must provide a list of all sites where the ECMs will be installed. Duke Energy requests that sites of similar size, hours of operation and energy-consuming characteristics be grouped together in one application for the determination of the incentive amount. The application should identify the site where each unique ECM will be initially installed. Duke Energy will conduct a pre-site inspection and install any metering and monitoring that may be required to determine the Approved Incentive Amount for each unique ECM. A post-installation site inspection will be conducted after each unique ECM installation. 6. Based on the information submitted with the application and the information gathered both before and after the initial installation of the ECM, Duke Energy will calculate the final Approved Incentive Amount for each ECM and remit incentive payment. 7. Duke Energy will conduct random site inspections of a sample of the locations where the ECMs are installed both prior to and after installation to verify installation and operability of the ECMs and to obtain information needed to calculate the Approved Incentive Amount. 8. The Payment Request Form must be submitted to Duke Energy within 90 days of completion of the projects associated with this application. Copies of equipment invoices must be submitted to Duke Energy with the Smart $aver Custom Incentive Payment Request Form. 9. If the vendor is the payee, the vendor must issue credit in the amount of the Custom Incentive to the customer on the invoices provided with the payment request submission. 10. Duke Energy will issue a Custom Incentive check, based on the final Approved Incentive Amount for each ECM, upon receiving the Smart $aver Incentive Payment Request Form from the customer. Approved Incentive Amounts may be adjusted if the project varies from the information originally submitted by the customer. 11. Customers are encouraged to retain copies of all forms, invoices and supporting documentation for their records. 12. Approved Incentive Amounts are valid for six months from the date communicated to the customer by Duke Energy. Duke Energy retains the right to adjust or terminate the Approved Incentive Amount Page 8 CustomIncentives@duke-energy.com Rev 12/15 Smart $aver Nonresidential Custom Incentive Application before the end of the six months due to regulatory requirements; measurement, verification and evaluation results; or any other valid reason. In some jurisdictions, incentive funds are limited and available on a first-come, first-served basis. 13. If the Incentive Amount needs to be adjusted for an ECM, Duke Energy will notify the customer of the adjustment as soon as possible. The Approved Incentive Amount, prior to the adjustment, will be valid for projects completed within 60 days of the date that Duke Energy notifies the customer of the adjusted Approved Incentive Amount. 14. Duke Energy reserves the right to recover all unrecoverable costs associated with the project approval if the customer decides not to complete the project, after the project is approved by Duke Energy. 15. Projects financially supported by other funding sources will be evaluated on a case-by-case basis for potential partial funding from Duke Energy. 16. Participants must be Duke Energy nonresidential customers with the project sites in the Duke Energy service territory. 17. Customers or trade allies may not use either the Duke Energy or the Smart $aver program name or logo without prior written permission. 18. Only trade allies registered with Duke Energy are eligible to participate. 19. All equipment must be new. Used or rebuilt equipment is not eligible for incentives. All old existing equipment must be removed on retrofit projects. 20. Energy efficiency equipment and systems acquired through both capital purchases and capital lease agreements are eligible for incentives. For equipment and systems acquired through capital lease agreements to be eligible for an incentive, the lease agreement must include a requirement that the Duke Energy account holder (lessee) purchase the leased equipment at the end of the lease agreement for a predetermined dollar amount or state that the title to relevant equipment automatically transfer to the lessee by the end of the lease term. 21. By accepting incentive payment, the customer and/or trade ally agree to transfer to Duke Energy the rights to all attributes of the energy efficiency projects or their operation. Attributes include, but are not limited to, any and all credits, benefits, emissions reductions, offsets and allowances, howsoever entitled, resulting from the avoidance of the emission of any substance into the air, soil or water at or by Duke Energy generating facilities through reduced generation of energy or other savings or offsets on account of the energy efficiency project(s). Customer will not claim ownership of any environmental attributes. Additionally, the customer and/or trade ally agree to transfer to Duke Energy the right to bid any energy efficiency, coincident demand and demand response resources associated with the projects into regional transmission organization (RTO) or independent system operator (ISO) markets. 22. Disclaimers: Duke Energy a. does not endorse any particular manufacturer, product or system design within the program; b. will not be responsible for any tax liability imposed on the customer as a result of the payment of incentives; c. does not expressly or implicitly warrant the performance of installed equipment. (contact your contractor for details regarding equipment warranties); d. is not responsible for the proper disposal/recycling of any waste generated or obsolete or old equipment as a result of this project; e. is not liable for any damage caused by the installation of the equipment or for any damage caused by the malfunction of the installed equipment; and f. reserves the right to change or discontinue this program at any time. The acceptance of program applications is determined solely by Duke Energy. Page 9 CustomIncentives@duke-energy.com Rev 12/15